Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 02979 | RI |
NPI | 1003015884 |
---|---|
Provider Name | Dr. Anthony J Gazzola JR. |
First Address | North Kingstown, RI 02852-2137 |
Second Address | North Kingstown, RI 02852-2137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 20/02/2012 |